TY  - JOUR
AU  - Fialova, Daniela
AU  - Laffon, Blanca
AU  - Marinković, Valentina
AU  - Tasić, Ljiljana
AU  - Doro, Peter
AU  - Soos, Gyongyver
AU  - Mota, Jorge
AU  - Dogan, Soner
AU  - Brkić, Jovana
AU  - Teixeira, Joao Paulo
AU  - Valdiglesias, Vanessa
AU  - Costa, Solange
PY  - 2019
UR  - https://farfar.pharmacy.bg.ac.rs/handle/123456789/3360
AB  - IntroductionThe importance of rational drug therapy is increasing with the aging of the population. Since one of the main reasons for inappropriate drug prescribing is also the age-blind approach, which results in ageist practices, this narrative literature review focuses on the description of the main barriers related to insufficient individualization of drug regimens associated with such age-blind approaches.MethodologyA narrative literature review using the PubMed, WoS, Embase, and Scopus databases was conducted by the EU COST Action IS1402. Experts in different scientific fields from six countries (the Czech Republic, Spain, Portugal, Hungary, Serbia, and Turkey) worked in four specific areas: (1) underrepresentation of older adults in clinical trials and clinical and ethical consequences; (2) insufficient consideration of age-related changes and geriatric frailty in the evaluation of the therapeutic value of drugs; (3) frequent prescribing of potentially inappropriate medications (PIMs); and (4) frequent underuse of highly beneficial nonpharmacological strategies (e.g., exercise).ResultsOlder patients are underrepresented in clinical trials. Therefore, rigorous observational geriatric research is needed in order to obtain evidence on the real efficacy and safety of frequently used drugs, and e.g. developed geriatric scales and frailty indexes for claims databases should help to stimulate such research. The use of PIMs, unfortunately, is still highly prevalent in Europe: 22.6% in community-dwelling older patients and 49.0% in institutionalized older adults. Specific tests to detect the majority of age-related pharmacological changes are usually not available in everyday clinical practice, which limits the estimation of drug risks and possibilities to individualize drug therapy in geriatric patients before drug prescription. Moreover, the role of somenonpharmacological strategies is highly underestimated in older adultsin contrast to frequent use of polypharmacy. Among nonpharmacological strategies, particularly physical exercise was highly effective in reducing functional decline, frailty, and the risk of falls in the majority of clinicalstudies.ConclusionSeveral regulatory and clinical barriers contribute to insufficient knowledge on the therapeutic value of drugs in older patients, age-blind approach, and inappropriate prescribing. New clinical and observational research is needed, including data on comprehensive geriatric assessment and frailty, to document the real efficacy and safety of frequently used medications.
PB  - Springer Heidelberg, Heidelberg
T2  - European Journal of Clinical Pharmacology
T1  - Medication use in older patients and age-blind approach: narrative literature review (insufficient evidence on the efficacy and safety of drugs in older age, frequent use of PIMs and polypharmacy, and underuse of highly beneficial nonpharmacological strat
VL  - 75
IS  - 4
SP  - 451
EP  - 466
DO  - 10.1007/s00228-018-2603-5
ER  - 

@article{
author = "Fialova, Daniela and Laffon, Blanca and Marinković, Valentina and Tasić, Ljiljana and Doro, Peter and Soos, Gyongyver and Mota, Jorge and Dogan, Soner and Brkić, Jovana and Teixeira, Joao Paulo and Valdiglesias, Vanessa and Costa, Solange",
year = "2019",
abstract = "IntroductionThe importance of rational drug therapy is increasing with the aging of the population. Since one of the main reasons for inappropriate drug prescribing is also the age-blind approach, which results in ageist practices, this narrative literature review focuses on the description of the main barriers related to insufficient individualization of drug regimens associated with such age-blind approaches.MethodologyA narrative literature review using the PubMed, WoS, Embase, and Scopus databases was conducted by the EU COST Action IS1402. Experts in different scientific fields from six countries (the Czech Republic, Spain, Portugal, Hungary, Serbia, and Turkey) worked in four specific areas: (1) underrepresentation of older adults in clinical trials and clinical and ethical consequences; (2) insufficient consideration of age-related changes and geriatric frailty in the evaluation of the therapeutic value of drugs; (3) frequent prescribing of potentially inappropriate medications (PIMs); and (4) frequent underuse of highly beneficial nonpharmacological strategies (e.g., exercise).ResultsOlder patients are underrepresented in clinical trials. Therefore, rigorous observational geriatric research is needed in order to obtain evidence on the real efficacy and safety of frequently used drugs, and e.g. developed geriatric scales and frailty indexes for claims databases should help to stimulate such research. The use of PIMs, unfortunately, is still highly prevalent in Europe: 22.6% in community-dwelling older patients and 49.0% in institutionalized older adults. Specific tests to detect the majority of age-related pharmacological changes are usually not available in everyday clinical practice, which limits the estimation of drug risks and possibilities to individualize drug therapy in geriatric patients before drug prescription. Moreover, the role of somenonpharmacological strategies is highly underestimated in older adultsin contrast to frequent use of polypharmacy. Among nonpharmacological strategies, particularly physical exercise was highly effective in reducing functional decline, frailty, and the risk of falls in the majority of clinicalstudies.ConclusionSeveral regulatory and clinical barriers contribute to insufficient knowledge on the therapeutic value of drugs in older patients, age-blind approach, and inappropriate prescribing. New clinical and observational research is needed, including data on comprehensive geriatric assessment and frailty, to document the real efficacy and safety of frequently used medications.",
publisher = "Springer Heidelberg, Heidelberg",
journal = "European Journal of Clinical Pharmacology",
title = "Medication use in older patients and age-blind approach: narrative literature review (insufficient evidence on the efficacy and safety of drugs in older age, frequent use of PIMs and polypharmacy, and underuse of highly beneficial nonpharmacological strat",
volume = "75",
number = "4",
pages = "451-466",
doi = "10.1007/s00228-018-2603-5"
}

Fialova, D., Laffon, B., Marinković, V., Tasić, L., Doro, P., Soos, G., Mota, J., Dogan, S., Brkić, J., Teixeira, J. P., Valdiglesias, V.,& Costa, S.. (2019). Medication use in older patients and age-blind approach: narrative literature review (insufficient evidence on the efficacy and safety of drugs in older age, frequent use of PIMs and polypharmacy, and underuse of highly beneficial nonpharmacological strat. in European Journal of Clinical Pharmacology
Springer Heidelberg, Heidelberg., 75(4), 451-466.
https://doi.org/10.1007/s00228-018-2603-5

Fialova D, Laffon B, Marinković V, Tasić L, Doro P, Soos G, Mota J, Dogan S, Brkić J, Teixeira JP, Valdiglesias V, Costa S. Medication use in older patients and age-blind approach: narrative literature review (insufficient evidence on the efficacy and safety of drugs in older age, frequent use of PIMs and polypharmacy, and underuse of highly beneficial nonpharmacological strat. in European Journal of Clinical Pharmacology. 2019;75(4):451-466.
doi:10.1007/s00228-018-2603-5 .

Fialova, Daniela, Laffon, Blanca, Marinković, Valentina, Tasić, Ljiljana, Doro, Peter, Soos, Gyongyver, Mota, Jorge, Dogan, Soner, Brkić, Jovana, Teixeira, Joao Paulo, Valdiglesias, Vanessa, Costa, Solange, "Medication use in older patients and age-blind approach: narrative literature review (insufficient evidence on the efficacy and safety of drugs in older age, frequent use of PIMs and polypharmacy, and underuse of highly beneficial nonpharmacological strat" in European Journal of Clinical Pharmacology, 75, no. 4 (2019):451-466,
https://doi.org/10.1007/s00228-018-2603-5 . .